Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Preoperative 3-Dimensional Planning and Patient-Specific Surgical Guides and Implants

J Hand Surg Am. 2017 Oct;42(10):836.e1-836.e12. doi: 10.1016/j.jhsa.2017.06.003. Epub 2017 Jul 12.


Purpose: Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique.

Methods: This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and the mean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months). Patient-specific osteotomy guides and custom-made plates were used for multiplanar corrective osteotomies of both forearm bones at the distal level in 1 patient and at the middle-third level in 4 patients. Patients were assessed before and after surgery after a mean follow-up of 42 months (range, 29-51 months).

Results: The mean planned angular corrections of the ulna and radius before surgery were 9.9° and 10.0°, respectively. The mean postoperative corrections obtained were 10.1° and 10.8° with corresponding mean errors in correction of 1.8° (range, 0.3°-5.2°) for the ulna and 1.4° (range, 0.2°-3.3°) for the radius. Forearm supination improved significantly from 47° (range, 25°-75°) before surgery to 89° (range, 85°-90°) at final review. Forearm pronation improved from 68° (range, 45°-84°) to 87° (range, 82°-90°). In addition, there was a statistically significant improvement in pain and grip strength.

Conclusions: This study demonstrates that 3-dimensional planned patient-specific guides and implants allow the surgeon to perform precise corrective osteotomies of complex multiplanar forearm deformities with satisfactory preliminary results.

Type of study/level of evidence: Therapeutic V.

Keywords: 3-dimensional planning; Forearm; malunion; osteotomy; patient-specific guides and plates.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Diaphyses / injuries
  • Female
  • Fracture Fixation, Internal / instrumentation*
  • Fractures, Malunited / diagnostic imaging
  • Fractures, Malunited / surgery*
  • Humans
  • Imaging, Three-Dimensional
  • Internal Fixators*
  • Male
  • Osteotomy*
  • Pilot Projects
  • Prospective Studies
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Surgery, Computer-Assisted
  • Tomography, X-Ray Computed
  • Ulna Fractures / diagnostic imaging
  • Ulna Fractures / surgery*